Form F399 - Affidavit Concerning Lost Check (Page 3 of 4) in pdf

Form F399 - Affidavit Concerning Lost Check Page 3

Mail completed form to:

30-30 47th Avenue, 10th Fl

Long Island City, NY 11101

If your lost check is for a:

-- Tier 3, 4 or 6 Loan, or

-- Refund (all tiers), or

-- Lump-Sum Survivor Benefit (Death in Service), or

-- Lump-Sum Pensioner Survivor Benefit

you can receive your replacement check by EFT

Electronic Fund Transfer (EFT) is an Easy, Fast,

Trouble-free way to have your payment deposited

directly into your checking or savings account.

Why EFT?

It is EASY: No trips to the bank in bad weather; no waiting in line to deposit the check.

•

It is SAFE: No risk of a lost or stolen check.

•

It is FAST: No waiting for the check to clear -- the money is available immediately to

•

make it easier for you to meet your obligations, regardless of storms or

natural disasters.

How to set up EFT for your replacement check:

• Complete the first two pages of this form to report your lost check.

• Fill out the form on the back of this page to provide your banking information. Follow the

instructions carefully.

• Mail or bring this completed form to NYCERS.

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A lost rollover check cannot be replaced by EFT, only by a paper check.

PENSIONERS, PLEASE NOTE: If you are receiving your monthly pension payment by

PAPER CHECK, you cannot use this form to request direct deposit. Your replacement payment

will be issued as a paper check. If you would like your FUTURE monthly payments to be direct-deposited,

you must complete and submit this form (Form 399) to report your lost check AND Form 380 --

Authorization for Electronic Fund Transfer (EFT). Form 380 can be downloaded from our website at

EFT....an Extremely Fast Transaction

R11/17

Page 3 of 4

Form F399 - Affidavit Concerning Lost Check Page 3